GPs, pharmacists can play roles in early AMD intervention

Community-based healthcare workers (HCWs) such as GPs and pharmacists can help reduce irreversible vision loss from age-related macular generation (AMD) in an ageing Malaysian population, say local experts.

While organizations such as the Malaysian Society of Ophthalmology (MSO) conduct health campaigns to educate the public on eye diseases such as AMD, HCWs can also improve early intervention by starting conversations about eye health with their patients, especially the elderly, said MSO president Dr Kenneth Fong Choong Sian.

AMD gradually destroys an individual’s central vision. While dry AMD takes years to progress to severe vision loss, wet AMD (caused by leaky blood vessels in the eye inducing macular swelling) can cause the same damage within weeks or months. However, treatment with periodic anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections can help slow down or halt degeneration.

Speaking at a recent Bayer-sponsored public webcast titled ‘Fighting Wet AMD for the Gift of Sight As We Age,’ Fong noted that AMD affects an estimated 6.4% of people aged 65 to 74 years and 19.7% of people aged 75 years and above worldwide. Of these, wet AMD accounts for 10% to 15% of AMD cases.

“Often when someone says they can’t see clearly, people assume it’s just a cataract,” said Dr Tara Mary George, consultant ophthalmologist, speaking at the same event. “But unlike cataracts, [wet] AMD is an irreversible sight-threatening disease.”

According to Fong, displaying Amsler grid cards or posters in clinics and pharmacies could assist in teaching patients about checking for distortions in their central vision. He added that the Amsler grid test is widely accessible regardless of patient literacy as it is purely visual and can be found easily on the Internet for home use.

Both George and Fong emphasized the need to encourage patients to go for urgent follow-up in the event of any noticeable abnormalities in vision. Fong added that it was important to tell patients that neither supplements nor eye drops can address AMD.

“There are many dubious treatments in Malaysia being sold online or at markets which claim to treat eye diseases including AMD,” said Fong. “As a result, many patients waste money and delay their visits to hospitals or eye centres for treatment, and some have ended up being permanently blind.”

Precautions with COVID-19

On treating AMD amidst the COVID-19 pandemic, George said that anti-VEGF injections for wet AMD are classified as urgent medical procedures by the MSO and the Academy of Medicine of Malaysia, and therefore should not be deferred.

“Sadly, [during the MCO] some patients were worried about COVID-19 and missed their injections, leading to some vision loss. Even if we were to resume the injections, often we cannot restore their sight to what it was before,” said George.

George added that patients under treatment should be advised to maintain the injection schedules they were previously on, and not to extend intervals beyond 2 additional weeks of initial scheduling. For safety, HCWs administering injections must wear mask and eye protection, and patients are also advised to wear masks as the procedure requires close contact.

“Even if [the patients] are in Red Zones in the country, they still need to receive treatment,” said George. “There may not be retinal specialists in every town, but every town has an ophthalmologist … we can do and have done phone consultations with ophthalmologists in the smaller towns to do injections for these patients during the MCO, so they don’t miss their treatments even with travel restrictions.”